AB0783 BARRIERS DELAYING THE EARLY DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS: DOES SEX MAKE A DIFFERENCE?
Authors: C. Fernández-Carballido, R. Almodovar González, X. Juanola
Journal: Annals of the Rheumatic Diseases (2022)

Background The diagnostic delay in patients with axial spondyloarthritis (axSpA) in Spain is almost 9 years, being about 2 years longer in women (1). MIRADDAS is an educational project focused on raising awareness among different specialties involved in the diagnostic journey of patients with axSpA (e.g. Primary Care, Rehabilitation, Orthopedic Surgery, etc.), with the objective of achieving an earlier referral and diagnosis, especially in women. Objectives To identify the present barriers hindering a correct and earlier diagnosis of patients with axSpA in Spain. Methods Rheumatologists with a broad experience in axSpA prepared a survey addressed to rheumatologists participating in an educational project (MIRADDAS). First, the participants answered a survey, then they received training that was disseminated locally afterwards. Results A total of 80 rheumatologists from different Spanish regions answered the survey. Almost all rheumatologists (94%) recognized that there is a diagnostic delay and that this is higher in women (85%). Participants stated that the most significant factors are: 1. the presence of generalized pain in women (83%) and 2. the historical assumption of a higher prevalence of axSpA in men. Most of the rheumatologists (65%) do not have referral protocols for axSpA, though more than half participate in multidisciplinary clinics with Ophthalmology and Dermatology. Of the patients referred due to suspected axSpA from other specialties, from 20% to 50% were finally diagnosed with axSpA, the majority coming from Primary Care. Regarding the diagnostic delay of axSpA, the barriers most frequently identified by rheumatologists are: lack of knowledge about the disease and sex and gender differences by other specialties and hence a tendency not to refer women with suspected axSpA. Other important barriers are the delayed referral to rheumatologist, lack of communication between different specialties, lack of time during the visits and the delay to perform the imaging tests. Conclusion Sex and gender differences of patients with axSpA seem to contribute significantly to the diagnostic delay. The lack of knowledge by other specialties about sex and gender differences in axSpA presentation was identified as one of the most important barriers for an early diagnosis of these patients. Targeted educational projects such as MIRADDAS could contribute to reducing and improving the diagnostic journey of women with axSpA, ensuring equal access to health care for men and women. References [1]Garrido-Cumbrera M. et al. Atlas of axial spondyloarthritis in Spain 2017: study design and population. Reumatol Clin. Table 1. Barriers detected related to the diagnostic delay in axSpA Score (mean)* Lack of knowledge by other specialties about sex and gender differences in patients with axSpA 4.2 Lack of knowledge by other specialties about axSpA in general 3.7 Lack of knowledge about axSpA in Primary Care 3.6 Other specialists do not usually refer women with suspected axSpA 3.3 Delay in the first visit with Rheumatology 3.2 Lack of time for the visits 3.2 Delay in performing imaging tests 3.2 Lack of communication with Primary Care 3.1 Lack of multidisciplinary communication with other specialties 3 Lack of nursing staff 2.7 Limitation by Primary Care to request HLA-B27 or MRI 2.7 Difficulty in interpreting sacroiliac lesions on MRI 2.7 Difficulty in interpreting sacroiliac lesions on X-rays 2.6 Delay in performing the HLA-B27 test 1.7 *Measured on a scale from 0 to 5; axSpA: axial spondyloarthritis; HLA-B27: Human leukocyte antigen B27; MRI: magnetic resonance imaging; X-rays: radiography. Acknowledgements MIRADDAS project was supported by UCB. The authors wish to thank all the rheumatologists that have participated in the MIRADDAS project Disclosure of Interests Cristina Fernández-Carballido Speakers bureau: I have received lectures’ fees from Abbvie, Galapagos, Janssen, Lilly, Novartis and UCB., Consultant of: I have worked as a paid consultant for Abbvie, Janssen, Lilly, Novartis, Pfizer and UCB., Raquel Almodovar González: None declared, Xavier Juanola Speakers bureau: I have received lectures’ fees from UCB, Abbvie, Pfizer, Novartis y Lilly